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By Dr. Kuvent, November 4, 2009 12:26 am

Many of us tend to think of spurs as being those old, pointed metal devices worn by cowboys on their heels in order to persuade (if that’s the right word) their horses into picking up the pace. You probably don’t think about it often, but many people are walking around today with intrinsic spurs coming off their actual heel bones! Unlike cowboy spurs, these spurs are made of bone and are actually a forward projection of the lower aspect of the “calcaneus” or heel bone. They play a unique and interesting role in the etiology of heel pain.

Much of the heel pain seen by podiatrists today is due to “plantar fasciitis” which is an inflammation of the connective tissue band running from the bottom of your heel to the base of your toes. Sitting just above and adjacent to the plantar fascia are numerous muscles which help the foot to maneuver. These structures are all closely attached to a small area on that front bottom part of the heel bone. As you might imagine, this creates a great amount of tension in that part of the heel, and over time the constant pulling of those soft tissues on the bone can lead to the development of a bony protrusion towards the direction of pull. Age, genetics, biomechanics, and other factors may all influence this phenomenon.

If you were to look at a foot model or an X-ray of a heel spur, you might be fairly surprised as they can get up to half an inch long and appear sharp-almost like a hook protruding from the heel. Actually, much of the pain involved is NOT due to the spur but rather to the inflamed soft tissues in the area. Thus, more often than not, treatment is aimed at relieving tension and irritation in the soft tissues as well as evaluating them for tears and other pathology.

Whether a spur is present or not, you should definitely visit your podiatrist if you’re having significant heel pain. He or she can evaluate it clinically and then order an X-ray or other test to see if spurring is actually present. A spur may in fact be causing the pain if it gets large enough and starts to compress on nerves in the area. The doctor can also evaluate the nature of the spur, which in some cases may help to rule out hormonal issues, arthritic disorders, and other systemic conditions. Furthermore, imaging and other diagnostic measures can help to indicate whether something else entirely-such as a fracture-is causing the pain.

Though often an incidental finding, heel spurs in certain cases can become critical to the evaluation and treatment of heel irritation. They may be the key to relief.

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By Dr. Kuvent, February 12, 2009 10:52 am

Most commonly, heel pain is caused by inflammation of the plantar fascia — the tissue along the bottom of your foot that connects your heel bone to your toes. The condition is called plantar fasciitis.
Plantar fasciitis causes stabbing or burning pain that’s usually worse in the morning because the fact that the fascia tightens overnight. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing, increased activities or after getting up from a seated position.

Plantar fasciitis usually develops gradually, but it can come on suddenly and be severe. And although it can affect both feet, it more often occurs in only one foot at a time. Be alert to; sharp pain in the inside part of the bottom of your heel, which may feel like a knife sticking in the bottom of your foot. Heel pain that tends to be worse with the first few steps after awakening, when climbing stairs or when standing on tiptoe. Heel pain after long periods of standing or after getting up from a seated position. Heel pain after, but not usually during, exercise Mild swelling in your heel

Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. But, if tension on that bowstring becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed. The causes of plantar fasciitis can be:

Physical activity overload

Plantar fasciitis is common in long-distance runners. Jogging, walking or stair climbing also can place too much stress on your heel bone and the soft tissue attached to it, especially as part of an aggressive new training regimen. Even household exertion, such as moving furniture or large appliances, can trigger the pain.

Arthritis

Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis.

Faulty foot mechanics

Being flat-footed, having a high arch or even having an abnormal pattern of walking can adversely affect the way weight is distributed when you’re on your feet, putting added stress on the plantar fascia.

Improper shoes

Shoes that are thin-soled, loose, or lack arch support or the ability to absorb shock don’t protect your feet. If you regularly wear shoes with high heels, your Achilles tendon — which is attached to your heel — can contract and shorten, causing strain on the tissue around your heel.